Individual
DESTINI BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1011 ROCK QUARRY RD, RALEIGH, NC 27610-3825
(919) 833-3111
Mailing address
1011 ROCK QUARRY RD, RALEIGH, NC 27610-3825
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
14384
NC
Other
Enumeration date
04/04/2024
Last updated
09/04/2025
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